MedicaidPrior AuthMedium impact
Submission of prior authorizations for transplant surgeries
Oregon Health Plan·OR · Transplant Surgery, General Surgery·Plan contract
Effective date
Jun 5, 2024
We identified it
Aug 19, 2026
Summary
The Oregon Health Authority has waived the requirement for Coordinated Care Organizations (CCOs) to submit transplant prior authorizations to OHA before performing surgery, effective immediately as of June 5, 2024. CCOs are no longer required to route transplant PAs through OHA for approval, though all other transplant-related contract requirements remain in effect. This waiver applies to CY 2024 and will be incorporated into the 2025 CCO contract.
Action Required
Effective immediately (June 5, 2024): Billing and authorization teams at CCO-contracted practices must cease submitting transplant prior authorizations to the Oregon Health Authority for pre-approval before surgery. Update internal authorization workflows to reflect that OHA submission is no longer required for transplant procedures. Ensure staff understand that while OHA submission is waived, CCOs must still maintain all other transplant-related contract requirements and may have internal authorization processes. Contact Cheryl Henning (Cheryl.L.Henning@oha.oregon.gov) with questions about remaining transplant requirements or contract obligations.